Dr. S. YAMUNA
Most girls complain of dysmenorrhea but very few seek medical attention.
Sixteen-year-old Aruna, of Std. XII, called her friend in the morning and informed her that she would not come to school that day. Aruna did not get up from bed. Her mother came to her room to find her curled up on the bed, crying. Aruna pleaded to her mother that she should be allowed to stay back from school.
Aruna has been having painful menstrual periods. She attained menarche at 13 years. She did not have pain till she was 15. The last few cycles have been extremely painful. This is the first time she is missing school.
Painful or difficult menstrual flow is termed as dysmenorrhea. It has been reported in almost 90 per cent of adolescent girls. It makes its appearance six to 12 months following menarche. The initial few cycles after menarche are anovulatory and may be irregular too. On the establishment of regular ovulation, dysmenorrhea also sets in. Very few girls seek medical attention for painful menstruation because they consider it as "normal". But it should be understood that dysmenorrhea could occur secondary to reproductive tract abnormality too. In addition, pain need not be tolerated when there are adequate methods to control it.
The severity of dysmenorrhea increases with the number of years after menarche. It can be graded as mild, moderate and severe depending on the limitation of daily activities and intensity of pain. When the pain is mild, with no interference with daily routine, it is mild dysmenorrhea. If the pain is severe enough to warrant intake of medication to continue the daily activities, it is moderate dysmenorrhea. Severe dysmenorrhea is said to occur when the pain is not alleviated by medication and associated with cessation of daily activities.
Teenage girls typically complain of pain either occurring with or immediately after the onset of menstrual flow. The pain is crampy, occurring in spasms and localised over the lower abdomen just above the genitals. It may be accompanied by nausea, vomiting, diarrhoea, headache, tiredness, low back pain, thigh pain, dizziness and fainting. This is primary dysmenorrhea, which happens in the absence of uterine pathology.
When the dysmenorrhea is secondary to reproductive tract abnormality it is secondary dysmenorrhea. Here the pain starts one or two days before the onset of the menstrual flow. Most common causes for this kind of pain are endometriosis, pelvic inflammatory disease, etc which can be associated with painful sexual intercourse and infertility after marriage.
As far as primary dysmenorrhea is concerned, treatment is aimed at alleviation of anxiety with reassurance and reduction of pain with analgesics, after an adequate evaluation. General measures include exercise, good nutritious diet, decreased caffeine and chocolate intake, and stress management. Adequate control of pain helps in handling other kinds of stresses well. Sometimes oral contraceptives have to be taken under medical supervision to stop ovulation to reduce the pain.
Primary dysmenorrhea is a cyclical phenomenon; hence treatment is necessary during each menstrual cycle. Parents should be sensitive to the needs of their adolescent and offer to seek help to make her enjoy the teenage years.
The author is a Chennai based Consultant Paediatrician and Adolescent Physician.
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